Hye-Seon Oh1, Hyemi Kwon1,2, Eyun Song1, Min Ji Jeon1, Dong Eun Song3, Tae Yong Kim1, Jeong Hyun Lee4, Suck Joon Hong5, Won Bae Kim1, Young Kee Shong1, Jung Hwan Baek4, Won Gu Kim1. 1. 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea. 2. 2 Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul, Korea. 3. 3 Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea. 4. 4 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea. 5. 5 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
Abstract
BACKGROUND: Total thyroidectomy and cervical lymph node (LN) dissection is generally recommended in patients with medullary thyroid carcinoma (MTC). However, there is no clear evidence for whom to perform prophylactic lateral neck dissection in MTC patients without evident lateral cervical lymph node (LCLN) metastasis in preoperative images. This study evaluated the preoperative features for predicting the LCLN metastasis of MTC. METHODS: The study included 26 MTC patients with LCLN metastasis at initial surgery (N1b group) and 47 MTC patients without any LN metastasis or recurrence of disease (N0-NED group). The association between LCLN metastasis and preoperative clinical and sonographic characteristics (size, location, solid component, shape, margin, echogenicity, calcification, and subcapsular location of the tumor) were evaluated. RESULTS: There were no significant differences in age and sex between the N1b and N0-NED groups. Preoperative serum levels of calcitonin >65 pg/mL were associated with LCLN metastasis (p < 0.001). In preoperative neck ultrasonography (US), patients in the N1b group were more commonly found with a larger tumor (>1.5 cm) of irregular shape with a spiculated margin and a subcapsular location than those in the N0-NED group (p = 0.029, p < 0.001, p < 0.001, and p < 0.001, respectively). Increases in the number of these LCLN metastasis-related features were significantly associated with higher risk for LCLN metastasis (p < 0.001). The presence of two or more predictors was an appropriate cutoff point for predicting LCLN metastasis of MTC with 73.1% sensitivity and 91.5% specificity. CONCLUSIONS: MTC tumors with high preoperative calcitonin levels (>65 pg/mL), larger size (>1.5 cm), irregular shape, spiculated margins, and subcapsular locations in the neck US are at higher risk for LCLN metastasis. MTC patents with fewer than two predictors might be suitable for treatment without prophylactic LCLN dissection.
BACKGROUND: Total thyroidectomy and cervical lymph node (LN) dissection is generally recommended in patients with medullary thyroid carcinoma (MTC). However, there is no clear evidence for whom to perform prophylactic lateral neck dissection in MTC patients without evident lateral cervical lymph node (LCLN) metastasis in preoperative images. This study evaluated the preoperative features for predicting the LCLN metastasis of MTC. METHODS: The study included 26 MTC patients with LCLN metastasis at initial surgery (N1b group) and 47 MTC patients without any LN metastasis or recurrence of disease (N0-NED group). The association between LCLN metastasis and preoperative clinical and sonographic characteristics (size, location, solid component, shape, margin, echogenicity, calcification, and subcapsular location of the tumor) were evaluated. RESULTS: There were no significant differences in age and sex between the N1b and N0-NED groups. Preoperative serum levels of calcitonin >65 pg/mL were associated with LCLN metastasis (p < 0.001). In preoperative neck ultrasonography (US), patients in the N1b group were more commonly found with a larger tumor (>1.5 cm) of irregular shape with a spiculated margin and a subcapsular location than those in the N0-NED group (p = 0.029, p < 0.001, p < 0.001, and p < 0.001, respectively). Increases in the number of these LCLN metastasis-related features were significantly associated with higher risk for LCLN metastasis (p < 0.001). The presence of two or more predictors was an appropriate cutoff point for predicting LCLN metastasis of MTC with 73.1% sensitivity and 91.5% specificity. CONCLUSIONS:MTC tumors with high preoperative calcitonin levels (>65 pg/mL), larger size (>1.5 cm), irregular shape, spiculated margins, and subcapsular locations in the neck US are at higher risk for LCLN metastasis. MTC patents with fewer than two predictors might be suitable for treatment without prophylactic LCLN dissection.
Authors: Fan Wu; Tianhan Zhou; Kaining Lu; Ting Pan; Yeqin Ni; Lingqian Zhao; Kecheng Jiang; Yu Zhang; Dingcun Luo Journal: Zhejiang Da Xue Xue Bao Yi Xue Ban Date: 2021-12-25
Authors: Else Marie Opsahl; Lars Andreas Akslen; Ellen Schlichting; Turid Aas; Katrin Brauckhoff; Anne Irene Hagen; Alf Frimann Rosenlund; Eva Sigstad; Krystyna K Grøholt; Lars H Jørgensen; Trine Bjøro Journal: Eur Thyroid J Date: 2019-04-29